Form Approved
OMB No: 0920-1275
Exp. Date: XX/XX/XXXX
“Promoting Adolescent Health through School-Based HIV Prevention”
Attachment 5
District Assistance Questionnaire Items
Public reporting burden of this collection of information is estimated to average 7 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-1275)
(Assistance provided from district to priority schools)
During the past 6 months, how often did your district interact with [Priority School] to provide technical assistance on sexual health education: (Choose one)
Never [If “Never” is selected, skip to Q3]
1 time
2 times
3 – 5 times
6 – 10 times
11 – 15 times
16 – 20 times
21 or more times
What sexual health education topics did your district provide technical assistance to [Priority School]? (Check YES or NO for each)
Understand current district policy or guidance regarding sexual health education instructional programs
Build the instructional competencies and skills of those delivering sexual health education
Develop and use a health education scope and sequence that includes learning objectives, outcomes and content for sexual health education
Assess the sexual health education instructional program using the Health Education Curriculum Analysis Tool (HECAT) or a similar assessment tool
Select an appropriate sexual health education instructional program
Deliver a specific sexual health education instructional program with appropriate fidelity
Make appropriate adaptations to the sexual health education instructional program
Develop interactive, relevant teaching tools and resources to engage students in sexual health education
Incorporate sexual health service related skills-based instruction into
sexual health education
Strategies to engage parents in sexual health education
During the past 6 months, did any staff from [PRIORITY SCHOOL] attend a professional development event provided by the district on any of the following sexual health education topics? (Check YES or NO for each)
Understand current district policy or guidance regarding sexual health education instructional programs
Build the instructional competencies and skills of those delivering sexual health education
Develop and use a health education scope and sequence that includes learning objectives, outcomes and content for sexual health education
Assess the sexual health education instructional program using the Health Education Curriculum Analysis Tool (HECAT) or a similar assessment tool
Select an appropriate sexual health education instructional program
Deliver a specific sexual health education instructional program with appropriate fidelity
Make appropriate adaptations to the sexual health education instructional program
Develop interactive, relevant teaching tools and resources to engage students in sexual health education
Incorporate sexual health service related skills-based instruction into
sexual health education
Strategies to engage parents in sexual health education
During the past 6 months, how often did your district interact with [Priority School] to provide technical assistance on sexual health services: (Choose one)
Never [If “Never” is selected, skip to Q6]
1 time
2 times
3 – 5 times
6 – 10 times
11 – 15 times
16 – 20 times
21 or more times
During the past 6 months, on what sexual health services topics did you provide technical assistance to [Priority School]? (Check YES or NO for each)
a. Assessing the capacity of schools to implement activities to increase student
access to sexual health services
b. Best practices for adolescent sexual health services provision including
making services youth-friendly
c. Basic sexual health overview including community specific information about
STD, HIV and unplanned pregnancy rates and prevention strategies
d. Recommended adolescent sexual health services
e. Laws and policies including minor consent for sexual health services
f. Incorporating sexual health service related skills-based instruction into sexual
health education
g. Importance of maintaining student confidentiality for sexual health services
h. How to provide parents with information about adolescent sexual health
services
i. How to make successful referrals of students to sexual health services
j. How to make school-based STD-testing events available
k. How to implement school-wide, student-led marketing campaigns
l. How to implement condom availability programs
m.How to ensure sexual health services are inclusive of LGBT students
n. How to create or use a student referral guide to sexual health services
o. Collaborating with SBHCs to improve student use and/or quality of sexual
health services
p. Assessing the capacity of districts to implement activities to increase student
access to sexual health services
During the past 6 months, did any staff from [PRIORITY SCHOOL] attend a professional development event provided or funded by the district on any of the following sexual health services topics? (Check YES or NO for each)
a. Assessing the capacity of schools to implement activities to increase student
access to sexual health services
b. Best practices for adolescent sexual health services provision including
making services youth-friendly
c. Basic sexual health overview including community specific information about
STD, HIV and unplanned pregnancy rates and prevention strategies
d. Recommended adolescent sexual health services
e. Laws and policies including minor consent for sexual health services
f. Incorporating sexual health service related skills-based instruction into sexual
health education
g. Importance of maintaining student confidentiality for sexual health services
h. How to provide parents with information about adolescent sexual health
services
i. How to make successful referrals of students to sexual health services
j. How to make school-based STD-testing events available
k. How to implement school-wide, student-led marketing campaigns
l. How to implement condom availability programs
m.How to ensure sexual health services are inclusive of LGBT students
n. How to create or use a student referral guide to sexual health services
o. Collaborating with SBHCs to improve student use and/or quality of sexual
health services
p. Assessing the capacity of districts to implement activities to increase student
access to sexual health services
During the past 6 months, how often did your district interact with [Priority School] to provide technical assistance on safe and supportive environments: (Choose one)
Never [If “Never” is selected, skip to Q9]
1 time
2 times
3 – 5 times
6 – 10 times
11 – 15 times
16 – 20 times
21 or more times
During the past 6 months, on what safe and supportive environments topics did you provide or provide funding for technical assistance to [Priority School]? (Check YES or NO for each)
Implementation of school-based programs in which students receive service-learning opportunities, that is community service designed to meet specific learning objectives
Implementation of school-based programs in which family or community members serve as role models to students or mentor students
Connecting students to community-based programs in which students receive service-learning opportunities, that is community service designed to meet specific learning objectives
Connecting students to community-based programs in which family or community members serve as role models to students or mentor students
Implementation of a student-led club that supports LGBT youth (often known as Gay-Straight Alliances or Genders and Sexualities Alliances)
Providing parents with information to support parent- adolescent communication about sex
Providing parents with information about how to support parent-adolescent communication about topics other than sex
Providing parents with information about how to monitor their teen (e.g., keeping track of their whereabouts, responding when they break the rules)
Providing parents with information to support 1-on-1 time between adolescents and their health care providers
Implementing classroom management practices
Supporting lesbian, gay, bisexual, and transgender (LGBT) youth (e.g., bystander intervention skills, implementing safe spaces, use of inclusive language)
During the past 6 months, did any staff from [Priority School] attend a professional development event provided or funded by the district (on any of the following safe and supportive environments topics? (Check YES or NO for each)
Implementation of school-based programs in which students receive service-learning opportunities, that is community service designed to meet specific learning objectives
Implementation of school-based programs in which family or community members serve as role models to students or mentor students
Connecting students to community-based programs in which students receive service-learning opportunities, that is community service designed to meet specific learning objectives
Connecting students to community-based programs in which family or community members serve as role models to students or mentor students
Implementation of a student-led club that supports LGBT youth (often known as Gay-Straight Alliances or Genders and Sexualities Alliances)
Providing parents with information to support parent- adolescent communication about sex
Providing parents with information about how to support parent-adolescent communication about topics other than sex
Providing parents with information about how to monitor their teen (e.g., keeping track of their whereabouts, responding when they break the rules)
Providing parents with information to support 1-on-1 time between adolescents and their health care providers
Implementing classroom management practices
Supporting lesbian, gay, bisexual, and transgender (LGBT) youth (e.g., bystander intervention skills, implementing safe spaces, use of inclusive language)
End
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Orenstein, Diane (CDC/OID/NCHHSTP) |
| File Modified | 0000-00-00 |
| File Created | 2023-08-28 |